Provider Demographics
NPI:1568614055
Name:OUZOUNOGLOU, IRENE (PTA)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:OUZOUNOGLOU
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 80TH STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141
Mailing Address - Country:US
Mailing Address - Phone:917-375-4225
Mailing Address - Fax:
Practice Address - Street 1:1893 NE MIAMI GARDENS DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:305-682-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21246225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant